Provider Demographics
NPI:1235725425
Name:HAMMOND, BEVERLEY BLACK (LICSW)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:BLACK
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:CHOCORUA
Mailing Address - State:NH
Mailing Address - Zip Code:03817-4677
Mailing Address - Country:US
Mailing Address - Phone:603-662-4509
Mailing Address - Fax:
Practice Address - Street 1:1001 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1828
Practice Address - Country:US
Practice Address - Phone:603-270-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical